MEDICARE: DR. DENISE A WELLS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	MD0024988	WA

General Provider Information

NPI Number	:	1467419382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE A WELLS MD

Provider Business Mailing Address
First Line	:	3161 ELLIOTT AVE
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98121-1099
Country	:	US
Telephone Number	:	800-860-0934
Fax Number	:	206-223-5550

Provider Business Practice Location Address
First Line	:	3161 ELLIOT AVE
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98121-1097
Country	:	US
Telephone Number	:	800-860-0934
Fax Number	:	206-223-5550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	12/05/2011

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